2004 ABOS Recertification Rules And Procedure

2013 ABOS MOC RECERTIFICATION EXAMINATION Applicants must have completed their MOC requirements prior to applying for the MOC/Recertification examination.

• February 1, 2012 Application available online at www.abos.org. • May 1, 2012 Deadline for application online and postmarked documents to be mailed. • May 15, 2012 Application late deadline with additional $350.00 late fee • October, 2012 Credentials Committee meets to decide admission of applicants to the examinations. Letters of notification mailed to candidates. • December 15, 2012 Case list due for oral examination. • December 15, 2012 Examination fee due for all pathways • February, 2013 ComputerPathways – Scheduling permits available online to candidates. • March/April, 2013 Computer Pathways -- Computer Administered Recertification Examinations, Prometric Technology Centers. • April, 2013 Oral Pathway -- List of 10 selected cases mailed to candidates. • June, 2013 Oral Pathway -- Admission cards online. • June, 2013 Combined Hand Pathway – Scheduling permits available online to candidates. • June, 2013 Computer Pathway exam results online to candidates. • July 22, 2013 Oral Pathway -- Practice-Based Oral Recertification Examination, Palmer House, Chicago. • August, 2013 Combined Sports Pathway – Scheduling permits available online to candidates. • August, 2013 Oral Pathway exam results available online to candidates. • September 9-21, 2013 Combined Hand Examination administered at Prometric Technology Centers. • October, 2013 Combined Hand Examination -Results available online to candidates. • October 24 – November 7, 2013 Combined Sports Examination administered at Prometric Technology Centers. • January, 2014 Combined Sports Examination -Results available online to candidates. 2

AMERICAN BOARD OF ORTHOPAEDIC SURGERY, INC.

Rules and Procedures for the Maintenance of Certification/ Recertification Examinations

Shepard R. Hurwitz, M.D. Executive Director

400 Silver Cedar Court, Chapel Hill, North Carolina 27514

Telephone: (919) 929-7103 Fax: (919) 942-8988 www.abos.org 3

The American Board of Orthopaedic Surgery reserves the right to make changes in its rules and procedures at any time and without prior notice.

January, 2012 4

2013 MOC/RECERTIFICATION EXAMINATIONS RULES AND PROCEDURES

TABLE OF CONTENTS

I. Introduction...... 1

II. Maintenance of Certification...... 2

III. The Maintenance of Certification/Recertification Examination...... 3

Practice-Based Oral Examination...... 5 Combined Hand Examination……………………….……………………………6 Practice Profile Examinations………………………..…………………………..7

IV. Impaired Physicians...... 7

V. Procedure for Application and Selection of Evaluation Option...... 8

Application and Examination Fees…………………………………...... 9

VI. Falsified Information and Irregular Behavior...... 9

VII. Credentials Decisions...... 10

VIII. Certification and Recredentialing by the American Board of Orthopaedic Surgery....11

IX. Unsuccessful Candidates for the Recertification Examination...... 13

X. Appeals Procedure...... 13 5

I. INTRODUCTION

A. Definition Orthopaedic surgery is the medical specialty that includes the preservation, investigation, and restoration of the form and function of the extremities, spine, and associated structures by medical, surgical, and physical methods.

B. Purpose The American Board of Orthopaedic Surgery, Inc. was founded in 1934 as a private, voluntary, nonprofit, autonomous organization. It functions to serve the best interests of the public and of the medical profession by establishing educational standards for orthopaedic residents and by evaluating the initial and continuing qualifications and knowledge of orthopaedic surgeons. For this purpose, the Board reviews the credentials and practices of voluntary candidates and issues certificates as appropriate. It defines minimum educational requirements in the specialty, stimulates graduate medical education, and aids in the evaluation of educational facilities and programs. The Board confers no rights on its diplomates. It does not purport to direct licensed physicians in any way in the conduct of their professional duties or lives. It is neither the intent nor the purpose of the Board to define requirements for membership in any organization or for the credentialing of staff privileges of any hospital. Maintenance of Certification, like certification, is a voluntary process.

C. Directors The directors of the American Board of Orthopaedic Surgery are elected from diplomates of the Board who are nominated by the American Orthopaedic Association, the American Medical Association, and the American Academy of Orthopaedic Surgeons.

D. Organization Directors of the Board elect a president, vice president, president elect, secretary, and treasurer annually. An executive director, who is a diplomate, serves as an ex-officio director of the Board. The president appoints directors to serve on standing committees on credentials, examinations, finance, graduate education, and research. Other committees may be formed as deemed necessary. The Board holds regularly scheduled meetings yearly.

E. Directory A current directory of certified orthopaedic surgeons is maintained by the Board and accessible to the public on the ABOS website. The names of diplomates also appear in The Official ABMS Directory of Board Certified Medical Specialists published by the American Board of Medical Specialties. 6

II. MAINTENANCE OF CERTIFICATION

Maintenance of Certification (MOC) is the process through which Diplomates can maintain their primary certificate in Orthopaedic Surgery.

1. MOC has been developed in response to external regulatory forces and public demand. The American Board of Medical Specialties (ABMS) has defined the general “competencies” of a competent physician. These include Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Professionalism, Practice-based Learning and Improvement, and Systems-based Practice. Each member Board must develop methods to systematically assess these competencies on a periodic basis as part of the maintenance of certification process.

2. These general competencies are to be addressed using the four components specified by the ABOS. They are: Evidence of Professional Standing, Evidence of Life-long Learning and Self-Assessment, Evidence of Cognitive Expertise and Evidence of Performance in Practice

3. The ABOS will evaluate a Diplomate through the MOC program using the four components as follows: a.Evidence of Professional Standing will require that the diplomate maintain a full and unrestricted license to practice medicine, and full and unrestricted hospital staff privileges in the United States or Canada. b.Evidence of Life-Long Learning and Self-Assessment will be addressed through on- going three-year cycles of 120 credits of Category 1 Orthopaedic or relevant Continuing Medical Education (CME) that include a minimum of 20 CME credits of Self-Assessment Examinations (SAE) and submission of a case list. c.Evidence of Cognitive Expertise will occur through a secure MOC/Recertification examination. d.Evaluation of Performance in Practice from the case list will include a stringent peer review process, and submission of a case list with a few performance indicators: sign your site, preoperative antibiotics, informed consent and postoperative anti-coagulation 4. To receive and maintain Board certification, Diplomates must agree to participate in the MOC process, and complete required milestones in the 3rd and 6th years after certification, apply for examination in their 7th year, and then take and pass a recertification examination in their 8th, 9th or 10th year. 5. A Diplomate who has not met the applicable MOC milestone requirements and submitted supporting documentation by the applicable deadlines will be designated as not “meeting Maintenance of Certification requirements” unless and until the Diplomate satisfies all applicable requirements. A Diplomate must complete the MOC requirements before he/she is eligible to sit for the MOC/Recertification exam. 7

6. For more information on Maintenance of Certification, go to the Board’s website, www.abos.org. Diplomates should check the website periodically to stay up-to-date of the Requirements and deadlines that must be met to maintain their certification status. .

A Diplomate must complete the MOC requirements before he/she may apply to sit for the MOC/Recertification exam. III. THE MOC/RECERTIFICATION EXAMINATION A. General Requirements In order to maintain his/her certification, a Diplomate must: 1. Complete and submit online and by mail all of the MOC requirements for his/her certificate expiration year for either the computer or oral pathway, and pay the MOC fee before he/she may apply to sit for the MOC/Recertification exam. A Diplomate, whose certificate expires before he/she completes the MOC requirements, will be required to take the Oral examination pathway. (See III.E.) 2. Possess a current, full and unrestricted license to practice medicine in all jurisdictions where the diplomate practices or holds a license... 3. Complete and submit (online and by mail) all of the application requirements and pay the application fee. 4. Successfully complete peer review and be approved by the Credentials Committee 5. Successfully complete one of the evaluation options for MOC/Recertification for which they have been approved.

A. License Requirement Applicants who are in practice at the time that they apply for the MOC/Recertification examination must possess a full and unrestricted license to practice medicine in the United States or Canada, or be engaged in full-time practice in the United States federal government, for which licensure is not required. An applicant will be rendered ineligible for the MOC/Recertification examination by limitation, suspension, or termination of any right associated with the practice of medicine in any state, province, or country due to violation of a medical practice act, statute, or governmental regulation; disciplinary action by any medical licensing authority; by entry into a consent order, by voluntary surrender of license while under investigation, or suspension of license. Any limitation, suspension or termination of an applicant’s license to practice medicine due solely to his or her entry into and successful participation in and/or completion of a rehabilitation or diversionary program for chemical dependency authorized by the applicable medical licensing authority shall not, by itself, disqualify an applicant from taking a certification examination. Applicants who voluntarily allow their licenses to lapse and who are no longer in the active practice of orthopaedic surgery may apply for MOC/Recertification, but will be restricted as to the examination options suitable to their status. 8

C. Credentials Committee Review

The applicant must demonstrate professional competence and adherence to acceptable ethical and professional standards. The applicant should not publicize him or herself through any medium or form of public communication in an untruthful, misleading or deceptive manner. Approval to take the MOC/Recertification examination will be determined by the Credentials Committee after review of the application, peer review, and any other relevant information provided to the Board. It is the responsibility of the applicant to provide the information on which the Credentials Committee bases its evaluation of his or her qualifications. This responsibility extends to information that the Credentials Committee requests from other persons. If the Credentials Committee does not receive requested information that it believes to be relevant from the applicant, a reference, a hospital representative, or another source, the Board will notify the applicant and will defer a decision to admit the applicant to the examination until the requested information is received and evaluated. When the information on an applicant is insufficient, the Credentials Committee may seek further input from local, regional, or national sources. The Credentials Committee may require that representatives of the Board visit the practice of an applicant if the Committee decides that this is necessary for an adequate evaluation of the applicant’s practice to decide whether to admit the applicant to the examination. Alternatively, the Committee may offer the applicant the opportunity to take the practice based oral examination for MOC/Recertification in lieu of a site visit of the practice. The Credentials Committee may direct an applicant, as a condition of approval to sit for MOC/Recertification, to take the practice based oral examination for MOC/Recertification where: 1. there has been a limitation, suspension, termination or voluntary surrender while under investigation, of the applicant’s medical license or any right associated with the practice of medicine in any state, province or country during the applicant’s most recent period of certification; 2. there has been a denial, limitation, suspension, termination or resignation, at the request of a hospital, of all or any portion of an applicant’s surgical staff privileges based on patient care issues during the applicant’s most recent period of certification; 3. a practice site visit report has identified significant questions as to whether an applicant’s practice demonstrates professional competence and adherence to acceptable professional standards such that the Credentials Committee determines that an oral practice based examination is necessary for an adequate evaluation of the applicant’s practice; and/or 4. the applicant fails a second time, after deferral of his or her application, to provide the Credentials Committee with the requisite number of individuals familiar with the applicant’s work, as specified in the application for recertification, to enable the Credentials Committee to conduct peer review and evaluate the applicant’s practice. 9

The direction by the Credentials Committee that an applicant takes the practice based oral examination as a condition of approval is subject to appeal pursuant to Article X “Appeals Procedure” herein.” The Credentials Committee may also direct an applicant not engaged in operative orthopaedic practice to choose a non-practice based or profiled evaluation option.

E. Evaluation Pathways

If the applicant has completed the computer pathway requirements for MOC, then they will select at the time of application computer examination option. The choices are: Combined Hand Examination, Combined Sports Examination, General Clinical Examination, Practice Profiled Adult Reconstruction Examination and Practice Profiled Spine Examination; provided that an applicant may be restricted as to the available examination options by determination of the Credentials Committee as specified in these Rules and Procedures.

Applicants who have allowed their certificate to lapse prior to completing their MOC requirements will be required to take the MOC Oral pathway, and take a Mandatory Oral examination. If an individual cannot provide a six month case list containing at least 35 operative cases, he/she will be required to take a computer examination, and provide a three month non-operative case list through the MOC system, and provide a list of all operative cases in a six month period for review by the Credentials Committee.

If the applicant has completed the oral pathway requirements for MOC, then there is no further selection.

PRACTICE-BASED ORAL RECERTIFICATION EXAMINATION

The practice-based oral pathway for MOC/Recertification consists of an examination on cases selected from a six-month case list prepared by the applicant. For the 2013 examination, applicants must submit a list of all operative procedures performed in a hospital, ambulatory care facility, or in any office setting for any consecutive six-month period during 2011-2012. A separate list must be prepared for each hospital, ambulatory care center, or office utilized by the applicant. 1. Case Collection: Cases are collected via the Scribe program which is accessible through the ABOS website (www.abos.org), using your MOC Username and Password Before you begin, you may view a layout of the case list data collection sheet by clicking on MOC/Recertification and then clicking on Sample Case List Data Sheet. All cases must be collected from each hospital and/or surgery center at which the applicant has operated during a consecutive six-month period. If the applicant did no cases during the case collection period, a letter from the hospital and/or surgery center must verify this fact. The letter must be sent to the Board office along with the case list. A candidate must perform a minimum of 35 cases during the collection period to be considered engaged in the practice of operative surgery. Once all cases have been entered and completed the applicant will print the case lists by hospital. No changes can be made to the case lists after this is done. Each complete hospital list 10 must then be certified by the director of medical records. The director of medical records' signature must then be notarized. 2. Case Submission: The Board must receive the following postmarked on or before

December 15, 2012:

a) The finalized printed case list for the required six month period. Each hospital list must be stapled separately and have the required signatures and notarization. Before mailing, the applicant should make three copies of the complete case list(s) as the copies the applicant must bring to the examination must be of these printed and certified lists. b) For each hospital or surgery center where no case was performed, the applicant must submit a letter from that institution stating that no case was performed during the six-month collection period. This information must be sent to the Board office by registered mail or courier of your choice (i.e. Federal Express, Express Mail, Certified Mail, etc.) to: ABOS, MOC/Recertification, 400 Silver Cedar Court, Chapel Hill, NC 27514. Case lists must be postmarked by December 15, 2012. The Board office will not verify receipt of case lists. 3. Case Selection: The Board will select 10 cases from the applicant’s six-month case list, which will be available online in mid-April. April. The applicant will also be required to upload pertinent images including arthroscopic prints for the 10 selected cases to the ABOS website. Detailed information on materials required to bring to the exam will be sent with the10 selected cases.

COMBINED HAND MOC/RECERTIFICATION EXAMINATION

The Combined Hand pathway is available only to candidates who hold a current CAQ in Surgery of the Hand from the American Board of Orthopaedic Surgery. This pathway consists of a multiple-choice computer administered examination. The examination will include approximately 160 questions designed to evaluate the candidate’s cognitive knowledge of clinical surgery of the hand and basic science relevant to surgery of the hand and will also include 80 general orthopaedic questions. This is a five-hour examination. This examination may be taken at Prometric Technology Centers. The tests are taken on IBM compatible computers. Candidates may pick from available dates and times at these sites during the month of September 9-21, 2013 Candidates who successfully complete this pathway will renew both their general orthopaedic certification and their certificate of added qualification in surgery of the hand. Both certificates will be dated from the expiration of the general orthopaedic certification if the Diplomate holds a time-limited certificate. If the Diplomate holds a lifetime certificate, or their certificate has expired, both will be dated from the date of the examination.

COMBINED SPORTS MOC/RECERTIFICATION EXAMINATION

The Combined Sports pathway is available only to candidates who hold a current Subspecialty Certificate in Orthopaedic Sports. This pathway consists of a multiple- choice computer administered examination. The examination will include approximately 120 11 questions designed to evaluate the candidate’s cognitive knowledge of orthopaedic sports and will also include 80 general orthopaedic questions. This is a four-hour examination. This examination may be taken at Prometric Technology Centers. The tests are taken on IBM compatible computers. Candidates may pick from available dates and times at these sites during October 24 – November 7, 2013. Candidates who successfully complete this pathway will renew both their general orthopaedic certification and their Subspecialty Certificate in Sports. Both certificates will be dated from the expiration of the general orthopaedic certification if the Diplomate holds a time- limited certificate. If the Diplomate holds a lifetime certificate or their certificate has expired, both will be dated from the date of the examination.

GENERAL CLINICAL MOC/RECERTIFICATION EXAMINATION This examination is approximately 200 questions, multiple-choice, computer examination. The questions are written by a task force based on current orthopaedic knowledge for each content area. The examination is criterion-referenced, which means that it is possible for all candidates to pass. This examination may be taken at Prometric Technology Centers in the United States and Canada. The tests are taken on IBM compatible computers. Candidates may pick from available dates and times at these sites during the months of March and April. This is a four- hour examination.

PRACTICE-PROFILED MOC/RECERTIFICATION EXAMINATIONS Two practice-profiled MOC/Recertification examinations will be offered in 2013. They are the Adult Reconstruction Practice-Profiled, and the Surgery of the Spine Practice Profiled Recertification Examinations. Each of the two examinations is approximately 200 questions, the content of which is approximately 80 general clinical orthopaedic knowledge questions and approximately 120 questions of the chosen subspecialty. The questions are written by task forces based on current orthopaedic knowledge for each content area. One score is given for the entire examination. These examinations may be taken at Prometric Technology Centers in the United States and Canada. The tests are taken on IBM compatible computers. Candidates may pick from available dates and times at these sites during the months of March and April. These are four-hour examinations. IV. IMPAIRED PHYSICIANS

A. Mental and Physical Impairment Applicants who have a mental or physical impairment that could affect their ability to practice orthopaedic surgery will not be admitted to the MOC/Recertification examination unless they present medical evidence from appropriate physicians, treatment centers, and hospitals which satisfies the Board that the impairment does not compromise their ability to render safe 12 and effective patient care. This documentation must accompany the application form. In addition, any such applicants may be site-visited by representatives of the Board.

B. Chemical Dependency An applicant for a recertification examination, who, within three years of his or her application, has been diagnosed as chemically dependent, has been treated for drug or other substance abuse and/or has entered a non-disciplinary rehabilitation or diversionary program for chemical dependency authorized by the applicable medical licensing authority will be required to present evidence to the Credentials Committee that he or she (1) has successfully completed the authorized rehabilitation or diversionary program or (2) is successfully enrolled in such a program or is successfully enrolled in or completed a private treatment program and presents attestations from the responsible program administrators and physicians demonstrating to the satisfaction of the Board that the applicant has been free of chemical dependency for a period sufficient to establish that the applicant is not currently using illegal drugs and/or that the use of illegal drugs or other substance abuse is not an on-going problem. They must also include a letter from his/her physician that the applicant can render safe and effective care. This documentation must accompany the completed application form.

C. ADA Accommodations

An applicant requesting an accommodation in the administration of a MOC/Recertification computer examination must submit a letter with the application requesting the accommodation and outling the basis for the request by the application deadline.

V. PROCEDURE FOR APPLICATION AND SELECTION OF EVALUATION OPTION

The dates and places for the MOC/Recertification examinations and the deadlines for submission of applications and fees are listed on the American Board of Orthopaedic Surgery website (www.abos.org). Examination dates may be changed at the discretion of the Board.

A. Application Deadlines 1. MOC/Recertification applications for the 2013 examinations are available February 1, 2012. To apply for the MOC/Recertification examination, go to the Board website www.abos.org , and enter the User Name and Password that you used for the MOC process, and follow the directions from there. Printed applications are no longer available. 2. The postmarked and electronic submission deadline for all required documents for application, those submitted electronically and those required to be mailed in, is May 1st of the year preceding the examination. These include: a) Electronic submission of a completed application and fee. b) Paper submission to the Board office of: •the printed signature page signed in three places •signed and original notarized hospital/surgery center letters Both steps must be completed by the May 1st deadline. 13

Late or incomplete applications. If the application is not submitted, online or if any of the required documents are not postmarked by the deadline the application will not be accepted and the received documents will be returned. If an applicant wishes to resubmit the MOC/Recertification application and late fee of $350 online after May 1st it must be finalized online and postmarked on or before May 15, 2012. No applications will be accepted after the final deadline. Late fees are non-refundable. 3. Applicants will indicate their choice of computer evaluation option on the application form. Once the application has been finalized, the chosen examination pathway may not be changed. B. Notifying the Board of Application Changes 1. It is the responsibility of all applicants to notify the Board office of any change of mailing and email address, practice association, or hospital affiliation. 2. If an applicant changes practice location or practice association or acquires new hospital staff affiliations, new references will be solicited by the Board. 3. An applicant is also required to notify the Board of the denial of any request for hospital privileges; of any action to restrict, suspend, or terminate all or any portion of surgical staff privileges; of any request by a hospital to resign all or any portion of surgical staff privileges; and of any action by a governmental agency which would result in the restriction, suspension, or probation of the applicant’s license or any right associated with the practice of medicine (including the entry into a non-disciplinary rehabilitation or diversionary program for chemical dependency whether by order or consent decree by the applicable medical licensing authority or on a voluntary basis).

C. Notifying the Applicant of Examination Admission

The decision of the Credentials Committee is mailed to the applicant no later than 60 days prior to the examination date.

D. Fees 1. Application Fees. The non-refundable application and credentialing fee of $975 must be submitted with the application form. 2. Examination Fees. The examination fees vary depending on the applicant’s choice of pathway. The fees are: a. Practice-Based Oral Examination...... $1350 b. Computer Administered General Clinical Examination...... $1040 c. Computer Administered Practice Profiled Examinations...... $1040 d. CAQ Combined Hand Computer Examination.,,,….…,,, $1,125 e. Combined Sports Computer Examination …………….….$1125 3. Other fees a. Late fee...... $350

VI. 14

FALSIFIED INFORMATION AND IRREGULAR BEHAVIOR

A. If it is determined that an applicant has falsified information on the application form, case list or the materials submitted in connection with the cases presented for oral examination, has failed to provide material information to the Board or has misrepresented his or her status with the Board to any third party, the applicant's application will not be considered for the MOC/Recertification examination and the applicant must wait three years before being allowed to file a new application, in addition, the applicant must abide by the MOC requirements. B. Examination applicants should understand that the following may be sufficient cause to bar them from future examinations, to terminate participation in the examination, to invalidate the results of an examination, to withhold or revoke scores or certificates, or to take other appropriate action: 1. The giving or receiving of aid in the examination, as evidenced either by observation or by statistical analysis of answers of one or more participants in the examination. 2. The unauthorized possession, reproduction, or disclosure of any materials, including, but not limited to, examination questions or answers before, during, or after the examination. 3. The offering of any benefit to any agent of the Board in return for any right, privilege, or benefit which is not usually granted by the Board to other similarly situated candidates or persons. 4. The engaging in irregular behavior in connection with the administration of the examination. 5. The altering or falsification of case lists and patient records or images, including, but not limited to, the failure to report complications and the manipulation of practice and surgical procedure patterns, during the case collection period, in a manner designed to hinder the Board’s evaluation of the applicant’s practice.

C. The following are examples of behavior considered to be irregular and which may be cause for invalidation of the examination or imposition of a penalty: 1. Referring to books, notes, or other devices at any time during the examination. This prohibited material includes written information or information transferred by electronic, acoustical, or other means. 2. Any transfer of information or signals between candidates during the test. This prohibition includes any transfer of information between the candidate and any other person at any time during the testing period, including bathroom breaks. 3. Any appearance of looking at the computer screen of another candidate during the examination. 4. Allowing another candidate to view one’s answers or otherwise assisting another candidate in the examination. 5. Taking any examination information, such as notes or diagrams, outside the examination room.

D. Applicants should also understand that the Board may or may not require a candidate to retake one or more portions of the examination if presented with sufficient evidence that the security of the examination has been compromised, notwithstanding the absence of any evidence of a candidate’s personal involvement in such activities. 15

VII. CREDENTIALS DECISIONS

A. Determining Admission to Examination 1. The Credentials Committee meets at least once each year to consider applications for the MOC/Recertification process. At this meeting, a decision will be made to approve admission to the next examination, to deny admission, or to defer the decision for further evaluation. 2. Diplomates whose certificates expire in or before 2015and who have completed the MOC requirements may apply for the 2013 examination. 3. A DECISION APPROVING ADMISSION TO THE 2013 EXAMINATION WILL APPLY FOR 3 YEARS. (This does not extend the expiration date on your certificate.) If the applicant fails to take and pass the MOC/Recertification examination within the 3 years, they will have to submit a new application after completing any additional Maintenance of Certification (MOC) requirements and be approved again by the Credentials Committee. B. Deferral of Admission Decision 1. A decision on an applicant’s admission to the MOC/Recertification examination may be deferred if information is insufficient for the Credentials Committee to make a judgment and/or warrants further investigation. Typically, in such circumstances, the Committee will defer such a decision for one year to gain further information. If it still has insufficient information to make a judgment, the decision may be deferred for a second year to enable representatives of the Board to conduct a site visit, or the Committee may require the applicant to take an oral examination. 2. A denial, reduction, restriction, suspension, termination, or resignation at the request of a hospital of all or any portion of an applicant’s surgical staff privileges, or pending action to do so, will normally result in a deferral until such action is finally resolved and the applicant’s practice has stabilized sufficiently for it to be evaluated. A change in location, type of hospital practice or practice association may also result in deferral. 3. A deferral of not more than two consecutive years is not viewed by the Board as an adverse action; thus, no appeal from a decision of the Credentials Committee is permitted unless an applicant has been denied admission or has been deferred for more than two consecutive years. A diplomate’s certification may be extended for the period of deferral by the Committee. C. Site Visit Representatives of the Board may visit the site of an applicant’s practice if the Credentials Committee believes that this is necessary for adequate evaluation of the applicant’s practice. D. Appeal of Admission Decision An applicant denied admission to the examination or deferred more than two years will be informed of the basis for such action and may request a hearing by an appeals committee of the American Board of Orthopaedic Surgery. (See section X)

VIII. CERTIFICATION AND RECREDENTIALING BY THE AMERICAN BOARD OF ORTHOPAEDIC SURGERY 16

Awarding Certificates The American Board of Orthopaedic Surgery awards a certificate to a candidate who specializes in orthopaedic surgery, has met the educational requirements of the Board, has demonstrated proficiency in orthopaedic surgery and adherence to ethical and professional standards, has passed both parts of the certifying examination. And has agreed to participate in and comply with the terms and conditions of the Board’s maintenance of Certification process. Once certified, in order to maintain certification, a Diplomate must meet additional requirements at periodic intervals over their ten year certification period in order to renew their certification prior to the expiration of their certificate. Certificates awarded after 1985 are in effect for a period of ten years subject to the satisfaction of Maintenance of Certification requirements. This portion of the Board’s responsibility is discharged by issuance of a certificate to an individual found qualified.

CANDIDATES WITH TIME-LIMITED CERTIFICATES WHO PARTICIPATE IN MAINTENANCE OF CERTIFICATION AND PASS THE MOC/RECERTIFICATION EXAMINATION WILL BE ISSUED TEN-YEAR, TIME-LIMITED CERTIFICATES DATED FROM THE EXPIRATION DATE OF THEIR CERTIFICATES PROVIDED IT HAS NOT EXPIRED.

For example: A successful candidate who has a time-limited certificate expiring in 2013 will receive a ten-year, time-limited certificate dated January 1, 2014 through December 31, 2023.

CANDIDATES WHO HAVE UNLIMITED (prior to 1986) CERTIFICATES AND WHO PARTICIPATE IN MAINTENANCE OF CERTIFICATION AND PASS THE MOC/RECERTIFICATION EXAMINATION WILL BE ISSUED TEN-YEAR, TIME-LIMITED CERTIFICATES DATED FROM THE DATE OF THE EXAMINATION. SUBSEQUENT RECERTIFICATIONS WILL BE DATED FROM THE EXPIRATION DATE OF THEIR MOST RECENT RECERTIFICATION (provided it has not expired). THESE CERTIFICATES DO NOT REPLACE THE ORIGINAL UNLIMITED CERTIFICATES, WHICH REMAIN VALID. THOSE WITH UNLIMITED CERTIFICATES WHO APPLY FOR MOC, BUT DO NOT PASS THE EXAM ARE STILL CERTIFIED.

Candidates who pass the MOC/Recertification examination may apply to the AMA for Category 1 CME credits. For more detailed information, contact the AMA at www.ama-assn.org.

B. Certificate Revocation At its discretion, the Board may revoke a certificate for due cause, including, but not limited to: 1. The Diplomate did not possess the required qualifications and requirements for examination, whether or not such deficiency was known to the Board or any committee thereof prior to the examination or at the time of issuance of the certificate, as the case may be; 17

2. The Diplomate made an intentional and material misrepresentation or withheld information in the application to either part of the examination or in any other representation to the Board or any Committee thereof; 3. The Diplomate made a misrepresentation to the board or any third party as to his or her status as a Diplomate of the Board. 4. The Diplomate engaged in irregular behavior in connection with an examination of the Board (as described under Irregular Behavior), whether or not such practice had an effect on the performance of the candidate on an examination; 5. The Diplomate was convicted by a court of competent jurisdiction of a felony or misdemeanor involving moral turpitude and, in the opinion of the Board, having a material relationship to the practice of medicine; 6. There has been a limitation, suspension or termination of any right of the Diplomate associated with the practice of medicine in any state, province, or country, including the imposition of any requirement of surveillance, supervision, or review due to a violation of a medical practice act or other statute or governmental regulation, disciplinary action by any medical licensing authority, entry into a consent order, or voluntary surrender of license; and 7. The Diplomate has failed to comply with the terms and conditions of the Board’s Maintenance of Certification process and the Maintenance of Certification Agreement.

A Diplomate may appeal the revocation of his or her certificates pursuant to the procedures set forth in Section X.

C. Certificate Reentry In the event a diplomate’s certification lapses or is revoked and the diplomate seeks to restore his or her certification, the diplomate will be required to satisfy all then applicable Maintenance of Certification requirements before certification is restored. In addition, if a diplomate’s certification has lasped for two or more years, unless the diplomate is not in active surgical practice and cannot produce a case list for at least 35 cases during the applicable reporting period, the diplomate must sit for and pass the oral recertification examination before certification is restored.

IX. UNSUCCESSFUL CANDIDATES FOR THE MOC/RECERTIFICATION EXAMINATION

Once the Credentials Committee has approved the applicant for the 2013 examination, their application is then valid for three (3) years. Should an applicant be unsuccessful in his or her initial examination, he or she may repeat the same examination pathway in subsequent years within the term of the application by paying the exam fee in the year preceding the desired examination date. If the applicant fails to take and pass the MOC/Recertification examination within the three years, their application will expire, and they will then have to repeat the MOC requirements again and then reapply to be considered for subsequent examinations.

APPEALS PROCEDURE

1. An individual who has received an unfavorable ruling from a committee of the Board may appeal such determination by mailing a notice of appeal to the office of the American Board of Orthopaedic Surgery within sixty (60) days of the date such ruling was mailed to him or her. EXCEPTION: The decision by the Examinations Committee that a candidate has failed a MOC/recertifying examination may be appealed only in the manner and to the extent provided in 7 and 8 of this section. 2. Upon receipt of a notice of appeal, the concerned Board committee shall consider any information submitted therewith by the individual in support of his or her appeal and make such further investigation as it deems appropriate. If the committee then decides in a manner favorable to the individual, it shall so notify the individual. If the committee does not so determine, it shall notify the individual and the president of the American Board of Orthopaedic Surgery in writing. 3. The individual shall then have the right to an appeal hearing to decide whether the determination of the concerned Board committee shall be confirmed, modified, or overruled in accordance with the hearing process described in this appeals procedure. a. The President of the American Board of Orthopaedic Surgery shall appoint an ad hoc appeals committee consisting of three directors of the Board who did not participate in making the determination being appealed, one of whom shall be designated by the President as chairperson of the appeals committee. b. In the event that the subject matter of the appeal involves complex issues of fact or issues not solely dependent upon medical, surgical, or professional standards, the President of the American Board of Orthopaedic Surgery, at his or her sole discretion, may appoint a hearing officer to conduct the appeal hearing and to submit a full written report and a recommended decision to the ad hoc appeals committee. The hearing officer appointed at the discretion of the President shall be an impartial physician, lawyer or other professional. c. The chairperson of the appeals committee shall convene a hearing before the appeals committee or the hearing officer, if one is appointed, within a reasonable time after their respective appointments but not less than sixty (60) days after the appointment of the appeals committee and the hearing officer, whichever is later. 4. prior to the hearing: a. The concerned Board committee shall provide the Executive Director with such written information concerning its decision as it deems appropriate; a list of witnesses, if any, whom it expects to call to testify; copies of any written materials that were considered in making the determination appealed (but only if the committee intends to present such materials at the hearing); and a list of information and documents which the individual is required to produce at the hearing. This material, together with written notice stating the time and place of the hearing, shall be sent to the individual by the Executive Director not less than thirty (30) days prior to the hearing. Not less than seven (7) days prior to the hearing, the concerned Board committee shall provide the Executive Director and the individual with copies of any written reports, affidavits, or statements of experts which the concerned Board committee intends to present at the hearing. b. The individual, not less than seven (7) days prior to the hearing, shall provide the Executive Director and the concerned Board committee with such written information concerning the individual’s position as the individual deems appropriate; a list of witnesses, if any, whom the individual expects to call to testify; and copies of any written reports, affidavits, or statements of experts which the individual intends to present at the hearing. 19

c. The Executive Director shall submit the written material referred to in this paragraph 4 to the members of the appeals committee or to the hearing officer, if one has been appointed, prior to the hearing, provided that a copy of such material is submitted to the individual and the concerned Board committee no later than the time it is submitted to the appeals committee or the hearing officer. 5. The hearing, whether conducted before the appeals committee or a hearing officer, shall be a hearing de novo. The concerned Board committee and the individual shall have the right to present all relevant information and evidence in support of their respective positions, and neither the concerned Board committee nor the individual shall be limited to the information and evidence considered by the concerned Board committee in making its original determination or its reconsideration of the original decision. a. The concerned Board committee shall have the burden of proving at the hearing that the determinations being appealed should be confirmed. The standard of proof to be applied by the appeals committee and the hearing officer in deciding whether the information and evidence presented at the hearing is sufficient to warrant confirmation of the determinations being appealed is by the preponderance or greater weight of the evidence. b. At the hearing, the concerned Board committee and its legal or other representatives shall present such relevant information and evidence as it deems appropriate to support its previously made determinations. However, the committee shall not have the right to present any information or evidence not previously provided as required under paragraph 4a. The committee and its representatives may call, examine, and cross-examine witnesses. c. The individual shall have the right to be represented at the hearing by legal counsel or any person of his or her choice. He or she may present such relevant information and evidence as he or she deems appropriate in support of his or her position. However, the individual shall not have the right to present any information or evidence not previously provided as required under paragraph 4b. The individual and his or her representative may call, examine, and cross-examine witnesses. The failure of the individual to produce information or documents requested by the concerned Board committee pursuant to paragraph 4a of this Article X shall be grounds for upholding and confirming the determinations of the concerned Board committee. The individual and his or her representative may call, examine, and cross-examine witnesses. d. The individual and the concerned Board committee may submit written statements at the close of the hearing. A written record of the hearing shall be made available to the individual at one-half the cost of its preparation. 6. after the conclusion of the hearing: a. If the hearing has been conducted before a hearing officer appointed by the President, the hearing officer shall prepare a written report based upon the information and evidence presented which shall include the findings of fact determined by the hearing officer and recommended decision as to whether the determinations being appealed should be confirmed, modified, or overruled. The hearing officer shall submit the written report to the appeals committee and send copies to the individual and the concerned Board committee. The individual and/or the concerned Board committee may file objections to the report and recommendation of the hearing officer with the appeals committee within ten (10) days after receipt of such report. The opposing party shall then have ten (10) days to file its response to such objections with the appeals committee. b. The appeals committee shall make its decision after having conducted the hearing or upon its receipt of the written report and recommendations of the hearing officer and the 20 objections and responses thereto filed by the parties. If a majority of the members of the appeals committee determine, on the basis of the information and evidence presented to them, including, when applicable, the report and recommendations of the hearing officer, that the determination of the concerned Board committee should be confirmed or modified, it shall so declare; but if a majority determines that the concerned Board committee’s determination should be overruled, it shall so declare. The appeals committee shall inform the individual and the concerned Board committee of its decision and the basis on which it was made in writing within a reasonable time following the hearing. The decision of the appeals committee with respect to the matter being appealed shall be final and binding. 7. A candidate who believes that the Practice-Based Oral MOC/Recertification Examination was administered in an unfair or inaccurate manner or that one or more of his or her oral examiners was acquainted with him or her or was not impartial, may immediately, upon completion of the examination, request that he or she be reexamined. The request shall be made to the chairperson of the Oral Examination Committee and reviewed by the President and the Secretary. If, after discussing the matter with the candidate and making such other investigation as they may deem appropriate, a majority of the President, the Secretary, and the chairperson of the Oral Examination Committee determine that reasonable grounds exist for the candidate’s request, he or she shall be immediately reexamined by another panel of oral examiners. In such event, the first oral examination will be disregarded and only the candidate’s performance on the reexamination shall be considered in determining his or her score on the examination. 8. A candidate who fails any computer administered MOC/Recertification examination may request in writing that his or her examination be re-scored by hand to certify the accuracy of the results as reported to him or her. Such a request is to be made within sixty (60) days of his or her being notified of the results of the examination. The request must be accompanied by a check for $100 payable to the American Board of Orthopaedic Surgery to cover the cost of hand scoring. There shall be no further appeal from a failure on any computer administered MOC/Recertification examination.